Differences between cardiogenic shock related to acute decompensated heart failure and acute myocardial infarction

The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS...

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Autores: Bertaina, Maurizio|||0000-0001-5727-4107, Morici, Nuccia|||0000-0003-1070-8857, Frea, Simone|||0000-0002-2977-3299, Garatti, Laura, Briani, Martina, Sorini, Carlotta, Villanova, Luca|||0000-0002-9406-4026, Corrada, Elena, Sacco, Alice|||0000-0002-8150-474X, Moltrasio, Marco, Ravera, Amelia, Tedeschi, Michele, Bertoldi, Letizia Fausta|||0000-0003-2062-3507, Lettino, Maddalena, Saia, Francesco|||0000-0001-9969-2649, Corsini, Anna, Camporotondo, Rita, Colombo, Costanza Natalia Julia|||0000-0003-1628-3642, Bertolin, Stephanie|||0000-0003-2233-3458, Rota, Matteo|||0000-0003-3928-5966, Oliva, Fabrizio, Iannaccone, Mario|||0000-0003-0571-3918, Valente, Serafina, Pagnesi, Matteo|||0000-0002-9298-7871, Metra, Marco|||0000-0001-6691-8568, Sionis, Alessandro|||0000-0003-0843-9512, Marini, Marco, De Ferrari, Gaetano Maria, Kapur, Navin K.|||0000-0002-8302-6796, Pappalardo, Federico, Tavazzi, Guido|||0000-0002-9560-5138
Tipo de recurso: artículo
Fecha de publicación:2023
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:300785
Acceso en línea:https://ddd.uab.cat/record/300785
https://dx.doi.org/urn:doi:10.1002/ehf2.14510
Access Level:acceso abierto
Palabra clave:Cardiogenic shock
Heart failure
Mortality
Myocardial infarction
Descripción
Sumario:The present analysis from the multicentre prospective Altshock-2 registry aims to better define clinical features, in-hospital course, and management of cardiogenic shock complicating acutely decompensated heart failure (ADHF-CS) as compared with that complicating acute myocardial infarction (AMI-CS). All patients with AMI-CS or ADHF-CS enrolled in the Altshock-2 registry between March 2020 and February 2022 were selected. The primary objective was the characterization of ADHF-CS patients as compared with AMI-CS. In-hospital length of stay and mortality were secondary endpoints. One-hundred-ninety of the 238 CS patients enrolled in the aforementioned period were considered for the present analysis: 101 AMI-CS (80% ST-elevated myocardial infarction and 20% non-ST-elevated myocardial infarction) and 89 ADHF-CS. As compared with AMI-CS, ADHF-CS patients were younger [63 (IQR 59-76) vs. 67 (IQR 54-73) years, P = 0.01], but presented with higher creatinine [1.6 (IQR 1.0-2.6) vs. 1.2 (IQR 1.0-1.4) mg/dL, P < 0.001], bilirubin [1.3 (IQR 0.9-2.3) vs. 0.6 (IQR 0.4-1.1) mg/dL, P = 0.01], and central venous pressure values [14 mmHg (IQR 8-12) vs. 10 mmHg (IQR 7-14),P = 0.01]. Norepinephrine was the most common catecholamine used in AMI-CS (79.3%), whereas epinephrine was used more commonly in ADHF-CS (65.5%); 75.8% vs. 46.6% received a temporary mechanical support in AMI-CS and ADHF-CS, respectively (P < 0.001). Length of hospital stay was longer in the latter [28 (IQR 13-48) vs. 17 (IQR 9-29) days, P = 0.001]. Heart replacement therapies were more frequently used in the ADHF-CS group (heart transplantation 13.5% vs. 0% and left ventricular assist device 11% vs. 2%, P < 0.01 and 0.01, respectively). In-hospital mortality was 41.1% (38.6% AMI-CS vs. 43.8% ADHF-CS, P = 0.5). ADHF-CS is characterized by a higher prevalence of end-organ and biventricular dysfunction at presentation, a longer hospital length of stay, and higher need of heart replacement therapies when compared with AMI-CS. In-hospital mortality was similar between the two aetiologies. Our data warrant development of new management protocols focused on CS aetiology.

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